- Diseases, Disorders & Conditions
Do You Shake? Essential Tremor Used to Be Called Benign Familial Tremor - The Scoop
Coping is the Norm
Millions of people, like me, my sister, and my grandmother shake all the time. Only 10% of them seek medical attention. For me, essential tremor (ET) means people think I'm nervous when I'm fine. ET means having to lean over my bowl of soup to get a spoonful to my mouth without spilling soup in my lap. If I get angry or afraid, I actually quake. When I used to sew up lacerations of skin, though, my work was unaffected. I got great cosmetic results. This is born out by practicing neurosurgeons who have learned to compensate for their tremors.
Essential tremor does tend to run in families. It can come on at any age including childhood. It tends to worsen and may get coarser with advancing age. You can see this age effect in Kathryn Hepburn in "On Golden Pond." This tremor can affect arms, legs, head, and voice. Alcohol lessens the shaking. No one knows the exact cause, but the fact that deep brain stimulation (a last resort surgical operation in severe cases) works to quiet ET is telling of an origin in the brain.
The International Essential Tremor Foundation (essentialtremor.org) offers information and helpful gadgets such as plates with bumpers. They are also advocating for an Essential Tremor Awareness Month to be designated by the U.S. congress.
Caffeine and nicotine worsen this tremor. Relaxation, meditation, and other stress reduction techniques may help.
The first-line meds for folks who decide they'd be happier with less tremor are inderal (a BP med), mysoline (a seizure med), and topiramate (a migraine treatment). Sometimes helpful is gabapentin, another seizure drug. It takes fairly high doses to improve ET, so side effects are an issue. Sometimes a combination is used to minimize side effects. Benzodiazepines such as Ativan and Klonopin are effective, but not the drugs of choice as they are addictive. As mentioned above, alcohol is effective and a couple drinks can be used to lessen ET for a special occasion. Alcohol is not recommended as a long-term treatment as it has lead to alcoholism in ET sufferers.
As of 2016, a new procedure is available for severe ET. High intensity ultrasound waves destroy one side of the thalamus (a communication center in the brain). Tremor tends to be improved to the point where quality of life is improved. It, however, is irreversible and can be associated with side effects such as gait disturbances.
I have been asked if I have Parkinson's Disease. I'm sure I don't. Parkinson's tremor occurs at rest and is accompanied by muscle stiffness and slowness. Essential tremor occurs while holding a posture or moving and has no accompanying symptoms.
Another common type of tremor is enhanced physiological tremor. Causes include overactive thyroid, medications (including antihistamines, lithium, and antipsychotics), muscle fatigue, and anxiety.